Merry Belated Christmas from the Hills!

This sums up whats been going on at our house-

Vote for LOLMax

This was submitted to I Has a Hotdog, the new doggie version of I Can Has Cheezburger.

Go HERE to vote for it to get on the page!

And I decided to put this on here just so Jesse would have an aneurysm from the cuteness.

Way Better than Bacon Salt

The t-shirts and magnets I received from my father and step-mom–




I don’t think we’ve mentioned it yet, but the Type B girls have a ridiculous gift exchange going. I have Jesse, Jesse has Katie, and Katie has me. I purposely didn’t get Katie b/c for her birthday, I got her bacon salt, and really, how can you top that? So anyway, when I received this in the mail, I automatically assumed it was from Katie. But no, from the dadoo. Good luck beating this Katie!

"He has more active cultures than the Middle East"

We’re waiting for our 10am patient in the conference room, listening to drug reps talk about insulin. They brought REALLY good coffee from the Atlanta Bread Co, so I am very happy to pretend to listen. Don’t worry, I’ve heard this spiel before. I’d be in trouble if I hadn’t b/c I’m a
little too distracted by my own thoughts.

Rep:
“Lantus is meant to maintain basal insulin levels…”

Me:
(Mmm coffeeeeeeeeee)

Rep:
“… an insulin drip maintained 4 days post surg decreases mortality by…”

Me:
(Oh god, so gooood. It doesn’t even need sweetener)

Rep:
“…so don’t use the sliding scale protocol, you should now use the subQ…”

Me:
(num num num… pretending to listen but actually blogging… and reveling in caffeine bliss…num num num)

Rep:
“…almost 66% of hyperglycemics are undiagnosed diabetics and…”

Me:
(oh thank you Jesus for caffeine, seriously why did I stay up so late watching An Inconvenient Truth? I have a 4-day weekend coming up and it was Netflix. The whole point of Netflix is there is no due date and now what will I watch this weekend? Maybe Hairspray. I should really study for the upcoming Internal Med test. I have no idea how to study for it though. I should talk to…)

My Doc:
“…I didn’t go but Michelle did… what did they say Michelle?”

Me:
(SHIT) “Huh? About what in particular?”

My Doc:
“Which receptor is inhibited in that niacin drug from yesterday?”

Me:
"Dp1 in the Langerhaans cell”

My Doc:
“Oh ok, ya, apparently that reduces flushing…”

Me:
(Smooth one, Hill)

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The "Go On Home" Test

Over lunch today, the other IM med students and I were discussing how we react when the resident tells us we can go home early. There are basically two ways to react:

1) Exclaim "Sweet!" and bounce on out the door.

2) Your internal monologue exclaims "Sweet!" but you just have to ask "Are you sure?" out of guilt.

I admitted to being the second type. Not even half an hour later, our resident said "Well, you can skidaddle if you want to." I couldn't help it, I had to ask "Are you sure?" He paused for a moment and said "Well, why don't you go make sure nothing's going on in the ER and then you can go." Naturally I ended up doing a two-hour complete H&P. As I was walking to the ER, one of the other med students said "That's what you get for asking," and bounced on outta there.

I'll probably still ask next time.

Poor Little Bunny

No truer video has ever been made.



P.S. Posted on dooce as well

P.P.S. I wrote another post: Michelle vs the ScutMonkey

Most physicians who go into family medicine prefer it to internal medicine because you really get to know your patients better, and you get to see what's going on with them long term and how things progress for them. It seems to me it's kind of the opposite in med school on rotations.
In my family practice rotations, I would meet patients once because I'm only there for a month, and I only saw a few of them a second time (usually the unfortunate ones). On my IM rotation, I see the same patients every day until they leave the hospital. With the post-op patients, that means I see them like 3-5 times. With the acute patients I see them at least twice. So I get to know people and see how their health issues get resolved.
That's my two cents for the day.

NPO after midnight or you'll turn into a gremlin!

I'm so not a morning person, however, I've gotten use to waking up super early (4ish, which is ungodly early for me). I've gotten use to having to answer questions for attendings at 6 a.m. Going to bed at 9 p.m. is fine now. But I still feel bad every time I walk into a hospital room at 5 a.m. and wake somebody up to ask them questions like "have you passed gas yet?" Maybe it will encourage people to get well quicker so they don't have to deal with med students asking questions about their bodily functions the minute they're jolted into reality.

A Lazy Yet Productive Weekend aka A Type B Weekend

Tasks completed:
-Scholarship applications
-5 Mahalo pages
-Case presentation
-Cleaned my whole house
-Sold 7 items on eBay
-Wrote a blog entry
-Wrote all my notes from 3 months of rotations into my IM book

Yet:
-slept in until noon every day
-watched 2 seasons of The Office
-caught up on Heroes
-managed to spend 9 hours in a row in front of the computer

I am most proud of the last accomplishment :)

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A Very Medstudent Thanksgiving

Or

“How am I ever going to decide if I can’t get past the first question?”

Oy, this month has got me leaning to the left.

Its funny the little rules we make in our head, or the things we keep telling ourselves and not really challenge.

I’ve been putting writing off for 2 reasons. One…I’ve been too busy, to state it plainly. Well, at least by the rules in my head. I figure if I have a case presentation and scholarship forms to do, I am too busy to write. I am also too busy to call anybody or to clean. But not too busy to watch TV. Funny how that works. Two…I don’t want to be one of those people who only write when they want to whine about something. I’ve had plenty of occasion this month to do so,
but not much to balance it out. I mean, there has been wonderful stuff, just in small doses compared to the econo-sized crankfest thats been going on this month.

Well, I overturned that rule in the last few days, starting with the cleaning. The place isn’t sparkling but hell, I vacuumed. That was like the 2nd time since we moved in. Today I’m writing b/c well, I need to. Its therapeutic for me, in that once I get out all those thoughts that
have just been rolling around in my head over and over again, it allows some new thoughts to finally break through. Many good thoughts, smart ones, with some wit and silliness, perhaps involving Johnny Depp or Heather Graham. Mmmm. Wait, what was I saying? Oh ya, too busy to call too. Ya, I’m going to try that this weekend, so if I owe you a call, be looking out for me. After I finish scholarships. Baby steps.

You know what’s also funny? How it is humor nature to only dwell on the negative. So, bleh, I am really tired of worrying in general. The 2 hour drive to the rotation site I took every morning and the drive home every night gave me ample quiet time to dwell on things. Things like getting kicked out of my rotation housing and the subsequent ass-raping of my integrity in the eyes of the dean. Things like how I am going to be fucked when it comes to the Internal Med test b/c I spend 4 hrs of valuable studying time in the car every day. And I especially dwell on the fact that the dwindling of my bank account by Dec is not likely to match up with the replenishment of loans in January.

Ok, bad things out of the way. Now, how to build up this month in my memory as something other than the month of ass-raping? Though that does have a ring to it, don’t you think? In the spirit of Thanksgiving, maybe I should focus on what I am thankful for this month:



1) Jesse came to visit me!

-She was here for a whole weekend and we rocked Boulder, I must say. We cruised the Pearl Street Mall, enjoying the local “color” (aka marveling at hippies & street performers), supporting the arts (aka buying hand-made greeting cards), and partaking of local fare (aka eating an orgasm roll at the BEST sushi place ever.) We finished outthe weekend rocking out to Guitar Hero III, laughing at the whitey white people dancing at the local bar, and buying Jesse a new wardrobe at Old Navy. Wow that weekend did my heart good. I am so lonely here, so the company was great, but talking to her was also an essential reminder that I am not crazy normally.

2) I was able to spend Thanksgiving with new friends.
-Just when Josh & I were wondering what we were going to do on the holiday, and how we could afford all the fixings we wanted, my 4th year mentor sent us an email inviting all stragglers to a Thanksgiving dinner at her place. When we got there, they had chicken instead of
turkey (we hate turkey!), homemade croissant rolls (that is our holiday tradition!), and real pumpkin pie with fresh-made whip cream (ohmigod, our fave dessert ever!)…it was amazing! How did they know?? Plus I was ecstatic to be talking to someone my own age, let alone fellow medical chica. I hope we can do something together again soon

3) Being poor brings out our creativity & makes us more thankful for what we have.

-Y’know, I talk alot of smack about how poor we are, but really, things could be so much worse, and in fact are worse for tons of people. We at least have a roof over our head, and no matter what, don’t ever have to worry about going hungry. Things are tight, but when they are, it makes a focus in on what we really need vs want. We get creative in how to stretch the most use out of something, and how to make a little extra money on the side. Most of all, it reminds me how close Josh & I are. We are both fiercely independent, and probably our biggest crime
is not really keeping eachother “in the loop” of what’s going on. We don’t plan dinner, we don’t call if we’re late, and we don’t go to bed at the same time. However, when things get stressful and money gets tight, we don’t argue or blame eachother. Rather, we band together and become a great team to figure out a way to survive and make our way out of it.



4) It was a great rotation!

-Almost worth the daily drive. I learned tons about medicine and its given me a new perspective on how to run a practice. Y’see, my doc was like an older version of the boss Michael Scott on the Office. He would waste 20min of a session just bullshitting with the patient, and make really corny and often times inappropriate jokes. His favorite was to diagnose an 80 year old woman’s problems as her being pregnant. His other one was to demand more complaints from the patient b/c he needed to make more money or else 1) he couldn’t afford the brothel he visits 3 times per week OR 2) he’d go home, beat his wife, and he can’t afford the alimony. But I did like him, and his patients LOVED him. Life Lesson #1, People like the abuse. They also were willing to wait an hour for him b/c they knew he gave them his undivided attention without any consideration of time. I also loved the staff. They said I was the first med student to treat them with any respect, so they helped me out and taught me things they flat out refused to do with other students. On the last day, they took my information and let me know that if I ever move back to the area, I’d have a whole office staff waiting for my practice. It was really sweet.



5) Friends, family, health, puppies, doing what I love…and all that other mushy stuff!

-I have the best friends I’ve ever had in my life, a family who loves me enough to visit me in Denver & nag me to tell them about whats going on in my life, a loving husband, 2 puppies I couldn’t imagine loving anything more until I have kids, Josh and I are both in careers we love, and we all have our health. I really don’t have the right to complain as much as I do!

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Medical Divorce

Went to my first tumor board today. It was pretty cool, nice to finally see some real pathology from actual patients. One patient had Burkitt's Lymphoma with the classic starry sky appearance, that one was particularly interesting. They had her on some sort of a port through her head to give her intrathecal chemo, I need to look that one up and see why intrathecal rather than systemic. It was nice seeing actual doctors review cases together and ask each other questions about why they handled certain cases the way they had. Also need to look up EGFR.

There was one patient who had had 4 stereotypic screening biopsies in two regions of her left breast, and one from each region showed pretty severe calcifications. It was documented that all physicians involved independently recommended a mastectomy, and the patient refused. A girl from my class spoke up and said she'd seen her in primary care, and she was a very difficult patient. She's a smoker with emphysema and uncontrolled diabetes, and she also has temporal arteritis but refuses to get a biopsy done. Between that and the diabetes, it's only a (probably short) amount of time until she goes blind. My classmate said her rationale for refusing the mastectomy is that she saw a program on TV where a lady had a total mastectomy and then ended up being cancer free. She firmly believed that when the biopsies were done, the cancer was now gone and she was cured.

The oncologist in the room said that it was important for all docs involved not only to chart that she'd refused the mastectomy, but also have her sign a paper saying the same. He said that he'd divorced her. A ripple went through the crowd that each doc involved had done the same, and her primary care was getting ready to.

Such an interesting term to use for basically kicking a patient out, divorced. I've much more commonly heard it referred to as firing a patient, but that one doesn't make a whole hell of a lot of sense either. Where does the responsibility of the doctor end and the responsibility of the patient begin? And how is it helping the whole situation if the doctors involved switch from being primarily concerned about the patient's well-being to being concerned about not getting sued? I guess it makes them more aware that the patient understand exactly what she's turning down, but I feel like the system is forcing us to compromise our ethics at times. I mean, I know the responsibility of the doc can only go so far, but it seems wrong that good doctors need to "divorce" a patient when they realize that the patient is an idiot and their risk of getting sued is too high. I wonder if the older docs, or I guess the middle aged ones who've dealt with this longer even realize how fucked up it is anymore. I hope they do.

Addendum:

EGFR is "epidermal growth factor receptor (EGFR; ErbB-1; HER1 in humans) is the cell-surface receptor for members of the epidermal growth factor family (EGF-family) of extracellular protein ligands." Yeah Wikipedia. I thought it was some sort of growth factor.

And here it talks about why to use intrathecal chemo in Burkitt's, there's a high chance of meningeal involvement.

And bam I was right that the Burkitt's translocation is t(8;14).

Question

Me:
"What's a technical way to say that she feels pain whenever her buttcheek jiggles?"

The Attending (stifles laugh):
"I think you just said it."

What I Remember

I remember the look on her face, the pain, the fear she wouldn't be able to breast feed after the surgery.

The teenage mother with no car who walked her baby's stroller to the office for every checkup. How she would never become the inadequate mother that her mother or sister were. Knowing she meant it.

The cries of new babies. How deliciously unfair it felt to be able to sit in the nursery and rock them while their mothers didn't even know. The realization that they might not all be perfect.

My hand on her chest, holding the retractor. Making it through the first sight of blood, the pus and infection, but starting to pass out when I thought about her breathing beneath my hands.

The morning I first became a doctor. Being in the room with them when she came in the day before, "dizzy," in the middle of a stroke. Watching silently, taking it all in, then going to get her son from the waiting room. That next morning in the hospital. Not even in med school yet, no clue what to say. She thanked me for taking such good care of her the day before, for being such a good doctor, and being there when she needed it. The amazement of this woman, so much older and wiser than me, looking up to me as her caretaker.

The rush, the intoxication of the first time in an OR. Playing the passive student, but internal monologue racing, telling the surgeon why she had lost her bearings on the camera. Confidence I forgot was mine, confidence that used to define who I was. Flashing back to correcting the teacher who was incorrectly teaching the other students how to read. Knowing I could have, would have been able to do the operation better. The thrill of rediscovering what it felt like to be me.

The fear of the first cut. The fear I wouldn't be able to handle it, that I would pass out or be sick. And once it started, never wanting it to end.

The Amish baby boy's steadfast, determined grip on my finger during his circumcision. His strong resilient personality showing itself only two weeks after birth.

When the pain stopped and osteopathy started.

The girl who said nothing. The teenager, impregnated by her uncle, hoping to deliver before the beginning of her freshman year of high school. The anger that she wasn't ever allowed to make the choice, regardless of what it would have been.

How he saw tonight. He saw right through me, grabbed the thought, and realized he was right. The split second look across the table, when everyone else disappeared, and seeing that he knew. Looking in through a window, seeing decisions I didn't know I had made. His excited smile of realization, I had already began to fall for it. Feeling that fraction of a second, shared only between us, being etched into my life.

Constant, nagging thoughts that I will never be good enough. Always trying to suppress it. The inequality of test scores and real life interactions. Knowing that not only am I equal to them, I am better. The hope that someday someone else will also see that.

"I'm going out on an osteopathic limb here, but..."

So here’s the long-awaited recap of the FP rotation. Finally. I know.

I really didn’t think I would love family practice as much as I did.
Maybe its the particular practice I was rotating in. It was just such a
light, fun, unhurried environment. Sure we had non-compliant patients,
and that is frustrating, and we saw WAY too many people for simple
colds. I’m sorry, I still don’t know which antibiotic I should give
just to get the patient to stop bitching. This was a point off on my
eval. Oh well. When there was an indication for antibiotics, here was
another problem:

Me: “She has maxillary sinus tenderness, nasal congestion, and
fluid in the ear all on the left side…I believe it is classic
sinusitis…she does not smoke and is otherwise healthy, so I am not
worried about atypicals, thus I would go with the same thing we used on
the child with sinusitis this morning, Amoxicillin for the infection
and nasal steroids to open up the airway, let’s go with Nasacort.”

Doc: “Go for it! Dosing?”

Me: “Shit”

I’m sorry but I don’t know dosages off the top of my head. My usual
resort was cussing and quickly flipping through my Tarascon
Pharmacopeia. This got me another point off…the having to cheat part,
not the cussing. They thought that was endearing

I was happy I got to do OMM. Actually I did lots of OMM, maybe one
out of every five patients. Some of the more interesting cases:

-I did the GI release on a colicky newborn and I’ll to take her
word for it, but the mom said he looked like he enjoyed it. I even
showed the mom how to continue it at home. No word on any exploding
diapers, but no complaints either.

-A cop came in with lower back pain she’d had for 2 years with
no relief. I adjusted her sacrum and cracked her lumbars. The pain was
down to 20% and she was ecstatic.

-A woman who’d had upper thoracic pain since her car crash 1
year ago came in with sever upper thoracic dysfunction &
tenderpoints, and occiput “weirdness” that made her feel a click every
time she swallowed. She’d been to physical therapy, chiropractors, etc
who had fixed it, only to have go back to hurting the next day. I gave
her cranial, then kneed her in the back when I couldn’t get the worst
of her thoracics. They were fixed, but I told her to come back in a
week to make sure. She did come back, and after one more knee-ing, she
has been pain & weirdness free.

-My first follow-up, as in someone who came back just to see me,
not the doc, was an older lady named Coleene. We thought she might’ve
broken her rib the week before, but decided to wait and see how some
muscle relaxants & NSAIDs made her feel. After a week of no
improvement, she came back specifically for OMM. I got an Xray just to
make sure, b/c it was so exquisitely tender. It came back clear, so I
spent like 45 min doing soft tissue, muscle stretching, and indirect
techniques to slowly loosen the area. She was so pleased with the
results and the fact that is was done naturally, that she gave me an
angel pendant b/c she wanted to BLESS ME.

-A woman with long standing chest “discomfort” came in with a
clean Xray, EKG, and specialist referrals. Nothing got rid of this
“weird, fluttering discomfort.” I noticed it was over her left 5th rib
and that she was already on OTC heartburn meds. I approached my doc
with the title line, b/c this is going out on a limb, but I thought she
should try a more potent GERD remedy b/c the 5th rib is a neurosomatic
point for stomach acid. He said that nothing’s helped the chest thing
before, so sure why not. We gave her some samples and told her to call
in for a prescription if the chest pain went away or another visit if
it didn’t. She called in the Rx

By the end of it, they let me do a few more things than just H &
P and OMM. I analyzed rapid streps and urine samples; I removed skin
tags; I even did a digital block (before I even learned exactly what it
was I was doing in my anesthesia rotation). And I was officially the
ear lavage queen and the suture bitch. Its nice to have a title.

Generally it was the same old, same old. Not to say that was boring,
b/c I had a great time talking with patients either way, just that
there were generally no big surprises in my day. Except for the whole
blood thing…

-Chief complaint: “I ejaculated pure blood.”

-Differential: 1) Vigorous sex, 2) Prostate cancer, 3) VD, 4) HE’S THE DEVIL!

And so ended my foray into primary care. I promised to return to
rotate 4th year (so like in 2 years!) and left them an ear to remember
me by.

Love,

Lavage Queen

aka Suture Bitch

aka the girl who knees people in the back and calls it a VERY direct technique

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Michelle's Rotation Journal

Hey everybody, I've been posting, I'm still around!

Ive just been doing it over at my website and have been lazy and/or too exhausted to hit ctrl-C to copy it over here, but I will from now on.

I'm actually off to St. Louis this weekend for a wedding and to party with my fellow Type B ladies, so that gives you a minute to head over to my site to get caught up before I start back up. Plus I'm sure one of us will report on the reunion. Us ladies haven't seen eachother since beginning of rotations!

Until then, I leave you with like 2 months of stuff to read on my site, plus this very, VERY inappropriately funny comic strip. Baby-killing is not funny, so don't laugh.



(HAHHAHAHAHAHAHA)

I'm going to hell.

~Michelle

My top 3 moments as a D.O.

#3-

Jesse and I hiding in a corner to look at our final anatomy grades

B/c my undergrad was stupid, pre-meds didn’t take anatomy and so my
first semester of med school, it was brutal. I knew it was down to only
a couple points. So close that I could only miss like 2 questions out
of 40 on the final practical. Once I heard the grades were in, Jesse
and I went down to the mailboxes and pulled out our grade slips. I was so nervous the my reaction was to ball it up and throw it in the corner! I
chased after it, hid in the corner, and uncrumpled the ball slowly,
revealing my passing grade of 70.5%, then screamed and jumped up &
down with Jesse.

#2-

Dancing to “Sexy Back” with the UAAO fellows

So it was the final night at the UAAO convocation in Colorado Springs
last year. They had their annual Fellows Banquet where all the fellows
converge and induct the new president and fellows. Its a big friggin’
deal, in the D.O. world anyway. All the top mindsy hold a dessert and
dancing reception. They played the typical music you play at wedding
receptions so every generation can dance. So, like, no rap or anything
beyond the 90’s. I’m bored after awhile, so, just to see if he’ll even
play it, I request Justin Timberlake. I didn’t think he would, and if
he did, that the older docs wouldn’t dance. But the next song up, there
it is! I wait for the dance floor to clear, but I actually see tons
more older docs getting up and joining in! By the end, they were not
only all dancing, but singing along! D.O.’s are so cool.

And tonight, I had my #1 moment…..

Getting shitfaced with my preceptors

I was invited to a dinner provided for by some drug reps, held at the
steakhouse up the street called Nine 75. Now, my docs are totally laid
back and lots of fun anyway, but over cocktails, they are a riot. I
walk in and one of the docs gives me a big hug, then hooks my arm to
head to the bar and gets me a martini. We stay hook armed, with me
introducing him to the 3 other med students from KCOM that showed up
(Yay!) and head to the room they’ve set up for the presentation. The
other 2 docs in the practice give me a hug and we sit down to
appetizers, like sushi and empenadas, and the waiter plies us with
wine. Our speaker is Sanjay Gupta (no, not the CNN doc, but you’d think
the confusion would have drawn more people in), an ENT surgeon who
presents on rhinitis. We get into a rousing discussion, interjected
with jokes and the occasional pimping. I get asked what the Kiesselbach’s plexus
is, and I have no idea, to which the doc replies “Oh man, you don’t
know the anatomy, your ass is grass tomorrow!” and I’m like, “I’m 3 drinks down and I got a 70.5% in anatomy, so no shit!”
Then we learned the best way to deal with rhinitis–> KY Jelly.
Remember, just don’t use the warming kind. We drink and eat and laugh
and tell stories for almost 4 hours, just enough time to sober up and
get back at a decent hour. God, that was fun.

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My texts & twitters

Awhile ago on dooce, she posted a link to some of her friends texts still stored on her phone, some from years back.

This has inspired me to post some of mine that I found. Enjoy.

Twitters:
- Its blowing my mind that OJ Simpson and Ian McShane (Al Swearangen!) were in Roots. And no, no one said cocksucker & it was the worse for it
- I did a name generator ie pimp name, porn name, etc...all STUPID except my punk band=CURIOUS MORMONS!
- Denver Culture Clash #2- Its easy to get confused about movie times when there is another movie theater ACROSS THE STREET.
- Denver culture clash #1- So, there are things called ghettos, & I shouldn't send Josh there to get $500. He had to pull his gun on somebody.
- katie and I found more japanes porn, why do they like sex w monsters and underage gils? (I was drunk)
- Nope , no cat-rabbits (Don't ask. I don't know either)
- Girls, prepare to be proud of me: I went to bed at 2am last night. Its 5pm now... I JUST woke up. (it was the day after boards)
- Just a can full of Jones Cream Soda helps the neurology go down
- I AM alive and am looking forward to hours and hours of Kidney.
- From my fave Mommy blog: 6yo daughter MC (to tune of I'm A Little Teapot): When I ride my pony into town, they Fuck! me over and knock me down
- Owwww. Can you pull your uvula?
- The flavor of the day is shittalottacrappa
- Jesse is a big stupid head. (my very first twitter!)

Texts currently on my phone:
- I have now officially seen the flattest pancake ass ever -from Katie
- I just talked to a guy from U of Utah, its not just our guys, all mormon wives are hot -from Jesse
- Honey get steaks for dinner, I can chew! -to Josh
- God or financial aid hates female doctors- to Jesse
- Denver has everything. I just passed a Casket Mart -to Josh, Jesse & Katie
- B like Bliver! -to Jesse
- Right now my fellow [McJob] employees are discussing their fave Steven Seagal movies. Aaaah! -to Josh, Jesse & Katie
- The high today was 100 and now its hailing. Am I still in MO? -to Katie & Jesse

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Oh My God! Katie's Blogging!

So today was day 1 of rotations, and it was...............awesome! I wrote up my first note and prescription (granted it was only sinusitis, but I was excited! Shut up! Look it was cool I swear, get off my back!) and I had to double check with the resident like twenty times to make sure I wasn't taking over some responsibility that only the grown ups get to do while I sit in a chair that's too high off the ground for me and swing my legs.
It also helps that the place I'm starting off at is a family practice clinic where everyone is super laid back. Just when I thought I was getting a little tired, the cell phone of the doc I was working with went off and the ring tone was "Chip, I'm gonna come at you like a spider monkey!" Yesss!
That is all for now, but I will make an effort to blog more often. Have no fear, good citizens. Wait, strike that, be afraid, be very afraid.

Med school videos

The Office: Med School Edition

Pitt Med: Above the Apathy

Osteostache Documentary Teaser

KCOM Orientation: Lawnmower Man

Jesse's advice to me tonight

"try to keep the dic out of your mouth tonight"

-dic as in D.I.C.- disseminated intravascular coagulation
b/c I bled about from my wisdom teeth removal about 24 hours longer than I thought I would

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Yay Updates!!

So I decided it was time to update this page.

I have removed all the ads, because they make the site look cheap and it's not like we've ever made any money off of them. Ever. So yeah, they're gone.

But more excitingly (is that a word? probably not) I've added a feed of my shared Google Reader links. Basically it's a list of anything from the blogs I read every day that I think is cool enough to share. I'm going to get on Michelle and possibly Katie to do the same. I say possibly Katie because she is good and doesn't have quite the same blog addiction that Michelle and I do.

Yay! Updates! Toy Store!

But I don't like Spam!

~Monty Python

I only ever get 2 types of spam:

1) Grammatically-painful personal emails concerning my penis

"Hello mvmedstudent- Take a last look at your penis, it will never be that small again"

"Hello mvmedstudent- Your penis start growing here"

"Hello mvmedstudent- You will be able to penetrate much more deeper"

"Hello mvmedstudent- Make your penis lllooooonnnngggggg....!!!"

2) Abstract poems about on sale office software

Yes. The obvious
Close at the end of distance the two Chose
In realms of dingy gloom and deep crevasse
Dreaming time has reversed, I watch drowned snow
Unreadable from behind—they are well down
Seized from creation by nonentity,
By the design of our own silent eyes
This perfection, this absence.
Is the moon to grow
demonstrating their talent for comedy—stroke
Merely a mockery of spring
Deep in the fog that quenches every ray,
Against which we have been projected? What . . .
Toward the still dab of white that oscillates
In dense bare branches, or the ubiquitous
From there. Toward . . .
Upon from the right by far trees, that white place
In Winter Haven, the ballplayers are stretching
I might have happily lived some other childhood.
Adobe on sale for $89.99.



Given by nature will soak into it.
III. Chronology of Northern Exploration
to restaurants for Early Bird Specials.
Not daring to oppose
That desire has ever built, have approached
Blurring the terrain,
That open before me? What I see
Archangel Winter, darkness on his back
Of meaning like these the world created by
Snow haze gleams like sand.
With my foot the supple ball, for perhaps
XV. The International Circumpolar Stations: The Greely Expedition
When Arctic winds crack down from Canada
Nor, indeed, the bit of paint itself can know of.
And off the white smoke swims
Summer bees were saying
Pierced by the mist that fades away,
Clear-voiced despite its years, strong, eloquent
I know, US $ 269.90 Creative Suite 3

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Mahalo! (or "Jesse is an Internet Whore")

Word up peeps. So I've been debating whether or not to post about this, because I don't want to be an internet whore or anything, but I decided that this actually is cool enough to post about. Or maybe I'm just a whore.

So here it goes. I've got this new search engine thing I've been working for for a month or so now called Mahalo, and they've just launched a new Firefox add-on.



Here's my link, click to download it: Mahalo Follow

The whole point of Mahalo is eliminating spam pages from searches, so you're not getting any spyware/adware with it. I promise. I wouldn't post about if there was any. I might be a internet whore, but I'm not a dirty whore. They're running a contest to try to get their part-time employees to spread the word on it, and I'm as of now winning an iPod shuffle, but could get an iPhone or a sweet new iMac if enough people download it from me.

I get 100 points for anyone who installs it and searches just once, so install it, restart Firefox, check it out, and then uninstall it if you don't like it.

I honestly think this is really cool though. This is a nice new idea for a search engine, a bunch of links on a single topic, hand picked by actual people, in one place with no spam pages included in the search. Then send your friends/enemies/parents/dogs/etc over here and have them download it from me. Or just send them the link. But make sure its mine so I get points. :)

Post comments and tell me what you like/don't like/any problems you have with it. I can get them straight to the programmers. I'm just good like that. :) Here's the contest page if anyone cares to watch my progress: Mahalo Follow Contest. I'm Jnpeacoc.

Oh and check it out, I'm a superstar. Go to blog.mahalo.com, 2 of my guides have gotten picked as "1 of our 5 favorite pages this week." For "Eternal Darkness (video game)" and "Pride and Prejudice" Because I'm a video game who was an English major who lays back and soaks up positive reinforcement. And an internet whore. Oh yeah, and a med student every now and then.

Life is a pre-existing condition

I am applying for new insurance and I tell them what the school requires, and then what I need, which isn't much. The only thing I take regularly is birth control (hey, I'm married, don't get any ideas.) Their response?

"Just to let you know, any time that you are taking current medications, they are considered pre-existing conditions on individual health plans, and more than likely, they will be EXCLUDED from the plan, possibly indefinitely."

Top 3 reasons this is stupid:

1. You'd think there would be a system in place to give medical students access to decent medical care. Not so much.
2. If I have been taking a drug before now and possibly have been for awhile, maybe its b/c I NEED IT and if I can't afford it b/c its not covered, then I might cost my insurance some money in dealing with whatever issue I was trying to prevent.
3. If birth control is indicative of a pre-existing condition, what exactly is that condition? Fertility? Being a woman??

Grr.

LOLMax

A little fun with Jesse's puggle- Dr. Max

How to spend a day preparing for rotations

Alternate title #1: Doing everything you won't have time for later
Alternate title #2: What to do on your day off from your McJob
Alternate title #3: What I did TODAY

1. Read up on the subject, i.e 250 Biggest Mistakes 3rd Year Medical Students Make
   
2. Then don't read up on the subject, as in, read whatever cool non-medical book you've been putting off.
   
3. Laze it up for as long as possible. Guitar Hero helps.
   
4. Work out. You need to build up that physical stamina you lost in exchange for mental stamina with boards. Plus none of your professional clothes fit anymore, fatty fatty two by four.
5. Get totally settled into your place. Getting the stuff out of the box isn't enough, you also need to put it somewhere.
6. Make your bed a comfy piece of heaven, so, like, replace those flat grody pillow you've had for 10 years.
7. Stock up on food at the Safeway or other bulk foods store. As long as its not Walmart. Fascist.
   
8. Call friends and family, or at least Google chat.
9. Work out all the drama. Cellphone...internet...apartment...insurance....husband. Whatever the problem, stop putting it off and fix it now or you never will. Shit, that reminds me, I need to call a dentist, and get new insurance, and overhaul my car, and...gah!
10. Enjoy the feel of the the summer breeze on your face. Soon you'll be stuck inside most of the time and 2 days later its winter.
    

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Blog Rounds 1: Learning to Drool on Command

Glad to see there are still people reading this blog. We all had to take a little break after boards and to finish the end of our second year. Much, much more on that from my POV still to come, stay tuned for a month or two and you'll get the good stuff.

So I read a lot of other blogs, probably way too many. The good ones often leave me thinking about far more than I end up writing in comments, but us three Type B girls often get into good conversations about why these posts appeal to/disgust/inspire/amuse us. I've decided to do some posting on here about why it is that certain posts hit a nerve, and call these posts "Blog Rounds."

I caught this post tonight. It's over on a not uber-popular (read: Michelle Au..yeah you know who I'm talking about) but BEAUTIFULLY written blog, Nobody wears a white coat anymore... The writer is a resident at a hospital in Indiana (my home state!). She is amazingly clear and insightful about what is happening around her, I highly recommend it.

She was writing the other day about a patient of hers that she had just diagnosed with amyloidosis, and despite everyone saying what a "nice" woman this was, the unfairness that she will most likely die soon of this horrible disease.

Here's the excerpt that moved me the most out of all this, bold and italics added for emphasis:

"A has systemic AL-type amyloidosis. It's a horrible disease in which a particular line of cells in the bone marrow is overproduced, yielding an excess of a particular protein, which then simply silts out into the spaces between cells. The only good thing about this disease is that when you stain amyloid with Congo Red and light it up with a polarized microscope, it glows a bright shade of green and looks very pretty. The prognosis is poor, the progression is relentless, and most people who have it die within the year."

The post is much deeper and longer than this. But I think I've just figured out what it is that hit me so hard about it. We're taught in the first two years of med school how to make quick associations that lead us to develop differentials. Any med student entering their third year in the States will quickly, in true Pavlovian nature, shout out "Apple green with Congo Red stain!" if you so much as mutter the phrase amyloidosis anywhere near them. (Go ahead, try it sometime, I dare you. Even if they don't shout it, I can guarantee you that a picture somewhat like the one posted here popped into their minds.)


What is difficult for so many of us to deal with during these first two years, though, is that these aren't just diseases we're dealing with, they're PEOPLE with diseases. These people have lives. They have families. They have hopes and dreams. We came into med school saying that we were here to help PEOPLE, not learn how to knee-jerk diagnose a disease. But that knee-jerk association is necessary to even begin to be able to help them.

Somewhere between the beginning of med school and now, we've, I've, forgotten at times that the people are what matter. It isn't that I think they don't matter, but it's hard to not get caught up in the tornado of memorizing facts and spitting them back out that med school can be.

I'm glad to see it put into perspective that sometime down the line, a few years from the constant onslaught of Scantron tests and lab practicals, this information still came back to her in residency. But it was somehow separate and a tangent to what actually mattered, the patient.

Med Q from the McJob

Is there such a thing as ketchup bottle squirter's thumb?

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LOLcat of Death

NEJM -- A Day in the Life of Oscar the Cat

Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves.

And Michelle's fave-

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I have Housisms on Facebook

"First, 'Hector does go rug' is a lame anagram. Want a better one for Gregory House? 'Huge ego, sorry.'"

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Quotes from CPR class

(first to set the scene: 8 groups of 3 in a semicircle, working on "manikins", "Staying Alive" quite literally playing in the background.)

"Do we change positions in 2 man CPR or do we just spin the baby around?" -OK that one was me

"Um, my baby's trachea popped out."
"To reinsert, peel his face off and grab it."

"It seems only men pass out in the video, how are we going to deal with boobs?"
"Whats really convenient is that everyone passes out in or near the hospital."

"Do you want the one that is damaged or the one that is lubed up?"

"Aw they dressed him up like a person."

Teacher: "Can you suggest some ways to remember everything you've learned today."
Class: Silence... but everyone thinking, "We just finished boards. I think we can handle remembering 2 breaths and 30 compressions for 2 minutes."
Teacher: "Well, at a party, you could bring it up and go through it with other guests as an icebreaker."
Class: Silence again... but thinking, "Ya, and then get punched for bringing up class while we're trying to get smashed."

Me taking my test, trying to be quiet b/c others are still talking the written portion-
Teacher: So you're in a bathroom with no one else is around, and see someone laying there unresponsive, what would you do?
Me: I would ask them if they are ok.
Teacher: Don't tell me, show me.
Me: But you asked...ok...uh, ma'am are you ok?
Teacher: Right but how would you say it?
Me: Uh, I'd shake her a little and be in her face.
Teacher: But how would you say it?
Me: How? Oh I guess very loudly.
Teacher: YES! You just kinda whispered it.
Me: Ya but we were told to whis...per...anyway, uh, next check breathing.
Teacher: Before that, what would you do?
Me: Nothing if nobody else is around.
Teacher: But you're in a bathroom.
Me: Where you said no one else is around.
Teacher: Well I would still shout just in case.
Me: Ok, I shout for someone to help then. Then I tilt the head, check for breath and there is nothing, so I give 2 breaths.
Teacher: What if that didn't work?
Me: Didn't work? To resuscitate her?
Teacher: No, what if the breaths didn't work?
Me: Like they didn't make the chest rise?
Teacher: Yes, what would you do then?
Me: Well, I would check for a foreign body.
Teacher: There isn't one, what else?
Me: There are a bunch of things I could do if I had the equipment I suppose.
Teacher: No no, what's something YOU could do?
Me: uhhhh....
Teacher: They mentioned it like a 100 times.
Me: uhhhh....oh, readjust the head tilt.
Teacher: YES!
Me: (in my head) AAAAAAAH!

-Michelle

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Dear Male Readers: Doctors don't strip their female patients

An exerpt from an awesome article about being a standardized patient:

Playing Doctor

Like many of the students, Dr. I was baffled by how to assess my
heart and lung function without breaching the fortress of my bra. Most
students, while listening through the stethoscope to my back, simply
worked around the bra. But Dr. I informed me he needed to unsnap it
(no, he didn't use the one-handed technique). Then he stood in front of
me, looked at my gown like a colonel contemplating an incursion, and
struck. He peeled off the top of the gown, dropping it into my lap,
slipped the bra off my shoulder, and left me hanging while he
protractedly listened to my heart. (Dear Male Readers: Doctors don't
strip their female patients.)

I sat there, as the tape ran,
debating whether to stop the exam. Sure he had on a white jacket and
was using a stethoscope, but in reality, Dr. I was no doctor, but just
a pimple-faced kid who'd taken off my bra. My pondering was interrupted
by an abrupt knock on the door. We looked over, and standing there was
the real doctor in charge of the program.

"No breast exam!" she
said firmly to Dr. I. He was left sputtering as she closed the door. I
redid my bra and put on my gown. Dr. I gamely tried to continue, but he
was so shaken he forgot to take my blood pressure, and before he could
get to my reflexes, an announcement over the PA said the time was up.
He had to put down his hammer like a contestant on Top Chef forced to drop the spatula before plating the side dish.

Apparenty at Georgetown they don't practice patient exams until 2nd year. For all I complain about it, this definitely makes me feel more confident in my education. I mean, at least I don't molest my patients. -Michelle

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COMLEX vs USMLE - a showdown where I lose either way.

1. REGISTRATION:
-COMLEX- sign up, pay, schedule and you're done. Pretty easy.
-USMLE- step 1)sign up and pay
step 2)get a photo, get your school to stamp something, mail it
step 3)wait
step 4)get e-mail confirmation and schedule it
winner: COMLEX,only one step = way easier

2. BREAKS:
-USMLE- A 10 minute break after every block? Plus lunch? I don't need all those. I'm taking my lunch break and that's it.
-COMLEX- I only get 2 breaks and lunch? But I neeeed breaks! You give me my breaks!
winner: USMLE, because I really only need breaks when they're not offered to me.

3. MULTIPLE QUESTIONS ON THE SAME CASE:
COMLEX has 'em, USMLE doesn't. So here are the pros and cons.
pros: 1) If you know something about a case, but that's not the first question they ask you, it could be the second. 2) If you know the answer to the first question about that case, it may help if the second question is a really simple question about your first answer. 3) Takes less time to read questions.
cons: 1) If you don't know the answer to the first question about a case, you might be screwed on the rest of them.
winner: COMLEX, clearly there are more pros than cons

4. MATCHING QUESTION:
COMLEX has 'em
winner: COMLEX, seriously who doesn't like matching questions?

5. NUMBER OF BLOCKS:
COMLEX- 8
USMLE- 7
winner: USMLE

6. PICTURES:
COMLEX- Is that what I think it is? It's a little fuzzy.
USMLE- Well clearly this is a nice picture. Not sure what the patient has, but it's a nice picture of it.
winner: USMLE, I like pretty pictures.

Okay, so it comes out as a tie. Regardless of which one's better I'd rather not take either of them again.........until next year when step 2 comes along.

Overheard on the first day of our last month of class

"We have ornithology next."
"Check that again, b/c this is just a hunch, but I don't think we are taking a class on birds."

"I'm so sleepy."
"Ya, this class on anesthesia is painful."

"You should follow that surgeon."
"Why? Is he good?"
"No, but you'll learn how to deal with complications."

Sound bites from the anesthesia video-

"Medicine is logic. If I can't think of it, then no one ever will."

"...he threw acid on prostitutes before ultimately killing himself."

"Med students of the past had parties with ether like today's students have beer parties or inhale marijuana."

A way to make a boards "a bit more interesting"

My proposal:

You should be able to mark whether you were just guessing. If you mark a question as a guess, then if you miss it, you just wouldn't get that point. If you get it right, you get 1 point.

Here's the interesting part. Say you were totally confident you knew the right answer. If you get it right, you'd get...2 points! But whoa now, if you get it wrong...you get 1 point deducted from your score!

Want to make it even more interesting? Set it up to where if you played it safe and marked guess on every single question, you'd need like a 90% to pass. So you'd have to gamble on the 2-pointers at some point.

Bwahaha!

In years to come, COMLEX test writers will site this entry as the reason I was never asked to contribute any questions to the boards.

This is your brain on studying too much (much like being on drugs)

A song I wrote today:

"Macaroni and cheese for breakfast...mmm its sooooo good...I don't care its not normally for breakast...b/c its so fucking cheesy and good"

Note the clever rhyme scheme.

"Josh probably thinks I'm high, but I'm not...I've just gone crazy...[pause]...crazy for macaroni & cheese!"

Best House quote EVER

House: "Now no praying, I don't want Him [God] taking the credit."

House does the test, figures out the problem, saves the day.

House: "One quick operation and you'll be fine."

Patient:"Oh Thank God!"

House:"Don't make me slap you!"

Oh osteopathy

So any of us that are DO students, or friends/significant others of a DO student know this conversation by heart. Yep, I'm talking about how you try to explain to a non-medical person wtf a DO is vs. an MD. My husband was visiting with some friends from the restaurant he worked at in college, and was trying to explain it to them. The conversation went like this:

Neil: Yeah, she's an osteopathic student, she'll be a DO.
Friend: So like a chiropractor?
Neil: Not really....kinda....like a doctor who can do that.
Friend: So she's a bone doctor.
Neil: Kinda.
Friend: So what's she going to do? Orthopedics?
Neil: Actually she's thinking either family practice or OB/Gyn
Friend: Wait, so does she like bones or vaginas?
Neil: I guess vaginas.

How To (Not) Successfully (Not) Fail the USMLE (or not) for D.O.'s

So I took the USMLE earlier today, and I thought I would pass along some tips for how to do as well as I did on test (mind you, score won't come back for six weeks, so I have no idea how I did)

1. Make sure you don't get enough sleep.
I worked really hard at this one. I recommend going to bed earlier starting several nights before the exam, and then toss and turn for a few hours before finally being able to fall asleep. But, be sure to wake up early every morning in hopes that by continually waking up early, you will be tired earlier. This plan should most obviously not be working when the night before the test, you go to bed at 10, toss and turn till eleven, go upstairs and watch 20 minutes of a Dateline show your brother's watching about catching child molesters, go back to bed, and then not actually fall asleep till after 2:38 (specifically).

2. Make sure you have trouble finding the testing facility. (I was really confused as to why building 2 came after buildings 1 and 3.)

3. Make sure you run into someone from your school who's taking step 2 of the COMLEX, and they start telling you how easy the test will be (sweet!), but immediately switch their pep talk to "dude, that's rough" when they find out you're taking the USMLE (ef!)

4. Almost pee your pants everytime you accidentally hit a key on the keyboard (it just takes you forward to the next question.)

But really it wasn't that bad.
Onward to the COMLEX!

Either I love being a doctor...

...or I'll do anything not to study.

I spent a good 40 min today removing a friend's bloody earwax. And I was disappointed when the other ear was okay.

Only in Med School

3:59 PM Jesse: i like dic and emboli

they're probably some of my favorite diseases

Michelle: hehe

i totally read that wrong

4:00 PM Jesse: LOL

Michelle: i was like you like dick, great, i figured

Jesse: wow

Michelle: hahaha

4:01 PM so i thought wow, penis emboli, that has to suck

Jesse: only in med school

A Productive Day (for once)

I got off to a late start today, but I did get through quite a bit of hematology. And got a 45 minute walk in while doing it, so points for me exercising.

Plan for tomorrow: finish off hematology, start to tackle pharm (ackkk!!! I'm HORRIBLE at pharm....oh well, gotta start some time)

But now that I'm back in civilization, I'm going to reward myself for studying with super-yummy Steak 'n Shake.

Don't Drink and Study

I came home on Saturday (6 hr drive from school) and we had a graduation/going away to Iraq party for one of my best friends. Which meant I went out afterwards. Which meant I got REALLY drunk.

Here's the drink list: (note: This isn't typical drinking for me! This was a CRAZY night!)

• SoCo and Lime shot
• Lemon Drop shot
• Long Island Ice Tea
• Red Headed Slut shot
• Adios, Motherfucker! (aka AMF)
  
• Double Captain and Coke
  

Needless to say, studying has not been all that good today. So plan for tomorrow:

-Review Goljan Hematology (luckily I actually used this and the QBank to study hematology initially)

-Go through one Clinical Vignette's practice test, using the answers in the back and taking good high-yield notes. Or maybe matching this up with Goljan's 100 High Yield notes. We'll see how well that one works.


Luckily I'll be back at undergrad tomorrow, and that means I'll be back in my library where I can get studying done.

A Very True Facebook Group

You might be in med school if...

(Keep in mind, I only picked ones that directly applied to us 3 girls!)

When drinking, you and your friends think that the increase in your AST/ALT tomorrow is going to be hilarious!

You still do drugs, but at least you know what they do to you. And never fail to inform those you're doing them with.

You blame neurotransmitters for anything going wrong in your life

You can have a conversation about the abscess you drained today while eating cream of broccoli soup without any problem at all. Or for that matter, over any kind of meal.

You have named a dead person…and talked to them about your stresses while finding their lumbar plexus (Mine & Katie's was Fred)

You know that specialties are pre-defined by personality type.

The drama in your life now is worse than it ever was in high school.

When you go out with non-medical students, you're abnormally quiet, because you don't know what to talk about besides med school. (Actually no, we just bore them with med school stuff)

You can name the four people in your class who are the question-asker, the arguer, the bigshot doctor's son/daughter and the stoner/alkie/druggie who's never IN class. (guess which one I am!)

You know countless dirty mnemonics for parts of the body, but couldn't tell anyone what the front-page headline today is.

Your life consists of three parts: studying, drinking, and sleeping.

You consistently tell people that they just don't understand how bad it really is.

You know that, in theory, you have a family and friends, but you can't place the last time you saw them.

You constantly find yourself saying things like "I just have to get to spring break" or "I just have to get through Step 1." (We just want to pass the boards!)

You question every day if you should drop out and open a coffee shop, then realize that as soon as you were two semesters into med school, you were too far in debt to be anything but a doctor.

People assume you know something when you tell them you're in med school, but you know that you haven't learned anything. (well, anything useful)

You've dissected a penis and can explain the way Viagra works.

People constantly ask what med school is like, and all you can think of to say is "It really sucks."

You've never had problems before, but 6 months into med school you're on birth control, an anti-depressant, an anxiolytic and sleep medication. (hey! it was over a year thank you very much!)

You can name 3 specialties you're interested in, then immediately rule two of them out because they don't pay well enough to pay off your debt. (or the residency is too long or hellish)

Half your class is Asian of some sort. The other half is Jewish. All of us are completely nuts. (actually here, the other half is mormon)

A "study group" is you, your syllabus, and your red bull. (Jesse!)

You've done physical exams on your roommate, boyfriend, girlfriend, and any close friends. (except for pap smears and rectals, and thats only b/c they said no)

You think "AWESOME!" if someone keels over in front of you.

You're still excited to see "real patients."

You speak only in acronyms and abbreviations; HIV, CMV, USMLE, Dx, Px.

Advisors tell you that you have to balance your life with med school, and then are baffled when you ask them how to do it.

You've been told by at least 2 mentors that you really don't want to go into medicine.

You've thought something like "what's another $10,000 in loans?"

You're really frightened by the thought of some of your classmates becoming doctors.

Grey's Anatomy, House, Scrubs, Dr. 90210, Nip/Tuck and ER are your favorite shows, but you point out all the wrong things in them all the time.

You have diagnosed yourself or others with at least 5 rare diseases ie PML, Kaposi's sarcoma, Measles, Rheumatic Heart Disease, etc.

Type B Exam Tip #4

Stop studying at least 2 hours before bed or else you'll be dreaming about Qbank.

And after a full day of Qbank already, you might go crazy and try to papercut your eye.

(One of these days! I'm gonna do it!)

Type B Exam Tip #3

For optimal productivity, maybe try getting up BEFORE noon.

Being a Type B is good for your heart

p.185 Psychologic Health and Testing

1) Type A Behavior (see Coronary Prone Behavior Pattern)
a) cluster of traits with increased incidence of coronary heart disease
b) traits: impatient, competitive, preoccupied with deadlines, highly involved with jobs
c) One major prospective study has shown that the Type A behavior pattern is associated with a twofold increase of coronary heart disease, even after controlling risk factors like smoking
d) Following the first heart attack, Type A's who survived had a lower chance of a second attack than did Type B's

I think Katie wrote this portion of the Comlex Review

p.176 Defense Mechanisms

4) Mature defenses-these defenses distort reality less than the other defenses and are thus considered more mature.
a) Humor-permits the overt expression of feelings and thoughts without personal discomfort
i. Example: A student smiles when he realizes that a particularly intimidating professor looks like a penguin.

See Katie- giggling everytime you think of penguins is actually very mature!

Jesse's Boards Plan

So here's my equation for boards, we'll see how it works out.

Great success!

And Qbank, but there's no good pic of that. How lame.

Sidenote: while searching around for pics, I came across this blog: Mike's High Yield Blog forW the USMLE Step 1. What do you think? Discuss amongst yourselves.)

Future Type B Surgeon?

So this is the convo I had with my dad and my little brother last night.

DAD (to little bro): Tell Katie what you decided you want to be.

LITTLE BRO: a cardiothoracic surgeon

ME: Awesome! But you'll need to work on being more of a dick.

DAD: Yeah, way more.

LITTLE BRO: What do you mean? To the patients or to everybody?

ME: Well, to the patients a little, but they won't care quite so much because, well, they need cariothoracic surgery, and they really just want to get it over with. But the staff will probably hate you.

LITTLE BRO: hmmm...

DAD: Think Dr. Cox on Scrubs

LITTLE BRO: So am I required to be a dick?

DAD: No, it's just a stereotype.

ME: Yeah, it really is just a stereotype. But it happens a lot. I think it's because in the OR the surgeon is looked at as the most important member of the medical staff and people just stay out of his way and don't really care as much if he's rude to them. But then when he leaves the OR, he still thinks he's the most important person, and everyone else is rolling their eyes.

LITTLE BRO: So how old will I be before I'm actually a cariothoracic surgeon?

ME: Early to mid 30's is my guess.

LITTLE BRO: But then when do I get married and have kids?

DAD: When you're a cariothoracic surgeon.

ME: Well, here's the thing about marriage in med school-

DAD (interrupts): You at least need to be done with your residency.

ME: (sigh) So here's the thing about marriage in med school, the people in med school who are married can't imagine not having a spouse arond to help out with the things like cooking a taking care of the house. The people who are not married, like me, are like "Ahhhhhhhh marriage! No!". As far as kids go, you get it a little bit easier because you at least don't have to deal with being pregnant, but you will never spend as much time with your kids as you wish you could, no matter what stage of your education or career you have them.

DAD: That's with any career though. I remember when I was in SWAT.

LITTLE BRO: So who wants to watch Scrubs?

Type B Exam Tip #2

Don't study on your bed.

I fell sleep at some point, dreaming that I was still studying. But then Neil Patrick Harris showed up and as awesome as Doogie helping me study for boards was, he wasn't very helpful on the OMM sections.

Type B Exam Tip #1

Don't read the "exam tips" section on studentconsult.com because all it will do is panic you at the fact that its 3 weeks till the big day and you should've started studying like 4 months ago.

(No dis to studentconsult.com, its otherwise awesome)

Signs I am spending entirely TOO much time online

So my favorite mommy blogger, dooce, just friended me on twitter. Convo with Michelle:

Michelle: yay! dooce made us her friend!

she is appearing on our twitter
Jesse: AWESOME!!!! i am officially FRIENDS with dooce!!!

i feel like i'm friends with like john lennon or something

I really should be studying surgery right now, but god nutrition is SO boring....SO boring......

Confrontation aka the creepy doctor test

Clinical definition:

Confrontation visual field exam. Your eye doctor sits directly in front of you and asks you to cover one eye. You look directly at your eye doctor while he or she moves his or her hand in and out of your visual field. You tell your doctor when you can see his or her hand.


What it actually looks like:

Apparently Paris Hilton goes to our med school

Overheard after test today-

"Gah, that was hard. My problem is all I do is study for boards. And that gets reeeeeeeeeeally boring. So I have a mirror propped next to me and I keep whipping out my hot pink lipstick and putting it on, then looking at it going "mmm....yeah....that's hot."

You can't make this shit up.

Studying renal....

Convo with Katie at 2am, putting together a study-guide for the internal med test tomorrow morning:

me: primary glomerulonephritis is done

Katie: you are my sunshine

my only sunshine

you make me happy

when skies are gray

me: lol you're on fire tonight

Katie: I've lost my damn mind

OK, so not a good strategy for boards

What color is your self-loathing?

Alternate title: I’ve been reading too much dooce lately.

I think I like the red. Red like righteous anger. Cue waving fists at the sky. (Wave harder boy, wave harder!)

Argh.

Cue realtime playback of my internal dialogue as a go through the day:

6:30AM: Ack my alarm, why for, how come you go off now? Oh ya, the test. Its not your fault I only got 2 hours of sleep last night, I apologize for punching you, alarm clock. Please don’t get your revenge by not waking me up from the nap I’m sure I’ll take later. Sorry, 7:30 tests piss me off. I know, though all tests this quarter have started at 8am, this one’s at 7:30am. Oh sure, because Michelle keeps passing all these tests despite her 10 hr/day loafing habit, lets see how she does if we continually chip a little more sleep away. Only in like half hour increments though ‘cuz maybe then she won’t notice. Bwahaha.

9AM: Ok, that test was less painful than I anticipated, I guess I’ll just check my e-mail, do a little surgery presentation review and then go take a nap. Let’s see…checking mail…nope, nothing! (Note this for later) Hmmm, what to review for surgery? I’ll go with some background on antidepressants and how they cause chronic constipation, then maybe how to do colonic lavage and manual fecal deimpaction. Mmmm. I really hope I get to talk about hooking up a catheter to the appendix and flushing everything out of the colon, while viewing on a proctoscope. I imagine it’d be like when you stand on the bridge after you ride the Tidal Wave at Six Flags. Whoosh!

10AM: …finally a nap. {head hits pillow for 2 seconds] Wait, what is that? WTF? Why is our lawn being mowed RIGHT NOW? Not 4 days after it was already mowed. And why do they keep banging the house right outside my bedroom window with the mower? I understand you need to get class but do you have to ram full speed into the house to do it? God/Buddha/Giant Spaghetti Monster- why won’t you let me sleep??

NOON: Well that 15 minutes of actual sleep was restful amidst the cutting of 1/4th of an inch off the lawn. And totally necessary. Because it really takes over an hour to mow the two thin strips of grass right outside the bedroom (the sarcasm thick as peanut butter here folks!) I suppose I should make an attempt to look presentable. Here, let me try putting in my contacts*RING* Ah! WTF?! [Answers phone] “Oh, you don’t say? We finally got the bill for the conference we’ve been trying to get for over a month and it has all sorts of odd drink charges like gin, margaritas, and $8 glasses of wine even though we made it clear to the vendor and the participants that it was only basic wine, beer and soda, nothing fancy? Oh, I see, and they also charged us for 97 drinks when there was only supposed to be 2 drinks per person and there was only like 30 people? Ya I’m gonna have to run the math, but I’d say thats supposed to be…uh…LESS. Hmm? HMM? Sorry can’t deal with this now. I know I no longer have time to put in contacts and do any kind of make-up or styling but I at least need to put on a bra and head out to do a presentation.”

1PM: Well our group doesn’t go on for a few minutes so I’ll nerd around on my pda and check my mail I haven’t checked in 3 hours. Oh whats this? An email saying my group met without inviting me. Or perhaps they just got my email wrong again and I missed it …sorry to break down this formula you have going, Mr. Assumes-everyone’s-email-is-their-first-initial-plus-their-last-name Guy, but my last name is the most common name short of Smith or Jones, so maybe you want to just look it up…it seriously takes 2 seconds. Well, they not only assigned me the one topic I have no knowledge of whatsoever, but also probably the #1 topic we’ll be pimped on! Thanks guys! I’ll become an expert here in 2 min from Wikipedia and then not answer anyway. I have perfected my “I could answer the question if I wanted to but I don’t want to be a show-off” confident stare. Fuck ‘em. We go up to do the presentation. We get pimped. They look at me. I look innocent. Someone else answers. See, not so hard.

2PM: Hi, Mr. restaurant manager/owner/mayor (no really, he actually is!), can you explain why there are only 45 tickets for drinks but we are charged for 97 drinks? Ya we counted, it doesn’t add up. And while we’re at it, can you explain why there are even mixed drinks on here when there was only supposed to be $4 wine & beer? Thats understandable you need to make a profit, sir, but its not what we discussed is it? I’m not sure why you are getting so defensive with me and lecturing me how no other restaurant would do these school event, and yes, I am sorry school events always cause you to lose money, but that is your problem. And actually, its a real easy problem to solve– don’t accept reservations/events where you anticipate losing money. I know I’m just in medical school, not the Wharton School of Business, but I think thats a pretty sound business practice. You know what else is? Not berating and generally being an asshole to consistent patrons. I’m outta here.

3PM: Can I take a nap now? PLEASE? Oh wait I promised I’d meet people at Yappy Hour. Dammit. Roxy, when are you going to learn to drive so you can take yourself? Oh, and pick up some milk and smokes on the way back.

4PM: Ever been so tired you CAN’T sleep? You waited too long and now its too late, you’re up? I waited too long. All I can do now is drink some rum, watch a movie, and chill out w/ Katie & Josh. Urge to kill lowering….lowering…what, Spidey isn’t on TV links?!…RISING…oh but Hot Fuzz is…lowering…lowering…gone


Aaaaaaaaw ya, boyeeee!

Things You Won't Find on a Routine Urinalysis

Very Cool 3D Medical Animation

National Geographic Wild: Med School Safari

My surgery group had to do a presentation today in front of the class, and then get pimped by the surgeon afterwards. Since we haven't done much of this, our whole group was a little stressed out before the presentation, so we were meeting to go over our facts. (About a disease we've never seen and surgical procedures we've never heard about before....talk about the blind leading the blind.)

Some of the other groups presented on Monday, and the people who were there (not me, I was at home sleeping) were talking about how the presentations went. I guess in one of the groups, midway through the presentation, one person walked away from their group and went and stood all by themselves on the other side of the room. That person ended up apparently getting grilled with questions at the end of the presentation.

A guy in our group brought up the fact that that's the way to get singled out, separate yourself from the group. "It's like National Geographic, separate the weak ones from the tribe, then attack!"

A particularly hilarious girl in my group (who I should get to guest post here) said, "Yep, it's just like that. Look over there! A zebra in the quicksand!"